tbuckley/cabot-search huggingface dataset:
Abstract 11963: Blood Level of Coffee-Eelated DNA Methylation and Long-Term Changes in Blood Pressure in Response to Weight-Loss Diet Interventions: The Pounds Lost Trial
Authors: Xiang Li, Xiaojian Shao, Catherine M Champagne, Qiaochu Xue, Elin Grundberg, Lydia A Bazzano, George Bray, Frank M Sacks, Lu Qi
Journal: Circulation (2022)

Introduction: Coffee intake has been associated with a lower risk of hypertension. Recent epigenome-wide association studies linked DNA methylation (DNAm) at PHGDH (cg14476101) with coffee consumption and blood pressure, which may explain the mechanism underlying coffee intake and blood pressure. However, little is known about whether the coffee-related DNAm is associated with long-term changes in blood pressure in response to dietary weight-loss interventions. Hypothesis: We hypothesized that participants with varying coffee-related DNAm levels may respond differently to dietary weight-loss interventions on long-term changes in blood pressure. Methods: The current study included 669 participants with overweight/obesity, who were randomly assigned to 1 of 4 diets varying in macronutrient components. Blood DNAm levels were profiled by a high-resolution methylC-capture sequencing at baseline. The regional DNAm at PHGDH was defined as the average methylation level over CpGs within ±250 bp of cg14476101. Two-year changes in blood pressure were calculated. Linear regression models were used to examine the associations between DNAm at PHDGH and 2-year changes in blood pressure in response to dietary weight-loss interventions, adjusting for age, race, sex, body mass index, anti-hypertensive medications, and concurrent weight loss. Results: Regional DNAm at PHDGH was not associated with 2-year changes in blood pressure in the total population. We found significant interactions between regional DNAm at PHDGH and dietary protein intake on 2-year changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p-interaction=0.018 and 0.005, respectively). Among participants assigned to an average-protein diet (15% of energy intake), higher baseline regional DNAm at PHDGH was associated with greater reductions in SBP (beta [SE]: -9.7 [3.4], p=0.005) and DBP (beta [SE]: -6.5 [2.4], p=0.007); while no association was observed among those assigned to a high-protein diet (25% of energy intake; p=0.40 for SBP, p=0.15 for BP). Conclusion: Our data indicate that participants with a higher regional DNAm level at PHDGH benefited more in long-term improvement in blood pressure when consuming an average-protein weight-loss diet.
Abstract 11881: Association of Post-Vaccination Adverse Reactions After Influenza Vaccine With Mortality and Cardiopulmonary Outcomes in Patients With High-Risk Cardiovascular Disease: The INVESTED Trial
Authors: Alexander Peikert, Brian L Claggett, KyungMann Kim, Jacob A Udell, Jacob Joseph, Akshay S Desai, Michael E Farkouh, Sheila M Hegde, Adrian F Hernandez, Deepak L Bhatt, Michael Gaziano, H Keipp Talbot, Clyde W Yancy, Inder S Anand, Lu Mao, Lawton S Cooper, Scott D Solomon, Orly Vardeny
Journal: Circulation (2022)

Introduction: Influenza vaccination is associated with reduced cardiopulmonary morbidity and mortality among patients with heart failure or recent myocardial infarction. The immune response to vaccination frequently results in mild adverse reactions (AR), which leads to vaccine hesitancy. We assessed the association between vaccine-related AR and morbidity and mortality in patients with high-risk cardiovascular disease. Methods: The INVESTED trial randomized 5260 patients with recent acute myocardial infarction or heart failure hospitalization to high-dose trivalent or standard-dose quadrivalent inactivated influenza vaccine. We examined the association between vaccine-related AR and adverse clinical outcomes in propensity-adjusted models. Results: Overall, 1968 participants (37.4%) experienced a vaccine-related AR. Compared to those without AR, post-vaccination AR, most commonly injection site pain (60.3%), were associated with lower adjusted risk for the composite of all-cause death or cardiopulmonary hospitalization, cardiopulmonary hospitalizations, all-cause death, cardiovascular hospitalizations and non-cardiopulmonary hospitalizations (Figure 1; Table 1). Conclusions: Post-vaccination reactions after influenza vaccine were associated with reduced risk of cardiopulmonary hospitalizations and all-cause mortality in patients with high-risk cardiovascular disease in propensity adjusted models, and may be a marker of a better immune response or overall health status, and should not deter future vaccinations.
Abstract 12514: Ceramide-Based Lipid Profiles and the Prevalence of Type 2 Diabetes Differ Between Patients With Coronary Artery Disease and Those With Peripheral Artery Disease
Authors: Andreas Leiherer, Axel Muendlein, Eva Maria Brandtner, Christoph H Saely, Alexander Vonbank, Arthur Mader, Lukas Sprenger, Maximilian Maechler, Barbara Larcher, Antti Jylha, Mitja Laaperi, Reijo Laaksonen, Winfried Maerz, Peter Fraunberger, Marcus Kleber, Heinz Drexel
Journal: Circulation (2022)

Introduction: Serum lipids and metabolic diseases, in particular type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD), predict the atherosclerotic diseases coronary artery disease (CAD) and peripheral arterial disease (PAD). However, it is not known in how far a more detailed characterization including serum lipids improves discrimination of PAD from CAD. Hypothesis: We hypothesize that ceramide-based lipid profiles and T2D status differ in CAD and PAD. Methods: A cohort of 274 statin-naïve patients with either PAD ( n = 89) or stable CAD ( n = 185) were referred to metabolic screening and were characterized using nuclear magnetic resonance- and liquid chromatography-tandem mass spectrometry based advanced lipid and lipoprotein analysis. Results were validated in an independent cohort of 1239 patients with PAD or CAD. Results: We found a significant difference in T2D prevalence and in the ceramide-based lipid profile between PAD and CAD patients. However, neither cholesterol-based markers (including LDL-C, HDL-C) and detailed lipoprotein profiles nor the NAFLD status differed significantly between PAD and CAD patients (figure). The difference between ceramide-based lipid profiles of CAD and PAD remained significant also after adjusting for body composition, smoking, inflammatory parameters, and T2D. Conclusions: We conclude that PAD and CAD differ in ceramide-based lipid profiles and T2D status, but not in other lipid characteristics or metabolic diseases.
Abstract 12034: Diffuse Myocardial Fibrosis, Its Distribution And Relationship To Clinical Outcome And Ventricular Function In Single Ventricles Before And After Fontan: A Cardiac Magnetic Resonance Outcome Study
Authors: Jeremiah Joyce, Michael Convery, Elizabeth Donnelly, Andrea Jones, Cassie Giner, David Biko, Matthew A Harris, Sara Partington, Kevin Whitehead, Michael D Quartermain, Laura M Mercer-Rosa, Mark A Fogel
Journal: Circulation (2022)

Introduction: Patients with single ventricle (SV) anatomy are susceptible to myocardial fibrosis as measured by cardiac magnetic resonance (CMR) imaging. This study investigated the association of diffuse myocardial fibrosis prior to Fontan with ventricular function and clinical outcomes after Fontan completion. Methods: Retrospective cohort study of consecutive SV patients who underwent CMR T1 mapping prior to Fontan. Native T1 time and extracellular volume (ECV) of the dominant ventricle and a free wall region of interest (ROI) were measured on CMR pre-Fontan. Longitudinal strain was measured on echocardiography pre- and post-Fontan. Associations between pre-Fontan fibrosis, strain, and clinical outcomes were evaluated using linear and logistic regression. Results: 40 patients were included (table 1). ECV directly correlated to the number of ICU days and post-Fontan strain. The coefficient of variation (CV) of ECV directly correlated to hospital and chest tube days. When limited to single right ventricles (RV), T1 directly correlated to strain pre-Fontan. ECV directly correlated to ICU days as well as strain pre- and post-Fontan. ECV ROI directly correlated to strain post-Fontan. The CV of ECV directly correlated to the number of hospital days (table 2). Conclusions: Myocardial fibrosis prior to Fontan may portend the clinical course after Fontan and should be considered for risk stratification. The CV of ECV is a novel measure of diffuse fibrosis that is associated with clinical outcome. For single RV patients, fibrosis before Fontan is associated with worse ventricular function after. The use of reverse remodeling agents prior to Fontan should be considered.
Abstract 11982: Clinical Outcomes of Outpatients With Suspected Covid-19 Treated With Chloroquine Compounds in Brazil: A Nationwide Telemedicine Study
Authors: Bruno R Nascimento, Gabriela Paixao, Luís Antônio B Tonaco, ana carolina D alves, David C Peixoto, Leonardo B Ribeiro, Mayara Santos Mendes, Paulo R Gomes, Magda C Pires, Antonio L Ribeiro
Journal: Circulation (2022)

Introduction: Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment. Methods: Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p&lt;0.10) were included in 4 multivariate models: 1: unadjusted; 2: adjusted for age and sex; 3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact). Results: In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260; G2: 871; G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p&lt;0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p&lt;0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p&lt;0.001; phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p&lt;0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28). Conclusion: Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.
Abstract 11422: Factors Associated With Improvement of Left Ventricular Function After Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure: A Multicenter Cohort
Authors: Marcos Roberto Queiroz Franca, Bruno R Nascimento, Reynaldo Miranda, Gustavo A Silva, Anna Terra Franca, Henrique B Moreira, Vitor Fontes, André D Naback, Lucas L Fraga, Lucas R Ruback, Antonio L Ribeiro, Andre A Carmo
Journal: Circulation (2022)

Introduction: Catheter ablation is a well-established therapy for atrial fibrillation (AF), with a promising impact on heart failure (HF) outcomes. We aimed to assess the impact of AF ablation on echocardiographic and clinical parameters in patients with HF, and to assess factors associated with improvement of the left ventricular ejection fraction (LVEF). Methods: Patients with HF and LVEF&lt;50% who underwent radiofrequency AF ablation in 5 high-volume Brazilian centers were prospectively enrolled. All patients underwent transthoracic echocardiography before the procedure and during follow-up, and the analysis by the examiner was considered. The primary outcome was LVEF normalization (≥50%) at follow-up. Clinical, echocardiographic, and procedural variables associated with the primary outcome were assessed by logistic regression. Results: From 2018 - 2022, 85 patients were included, being 59 (69%) males, mean age 66±12 years. Of these, 27 were in NYHA functional class 3/4 and 71 (83%) had persistent AF. Pre-procedural LVEF was 38±7%, and 25 (29%) had LVEF&lt;35%. Complications occurred in 3 patients (2 vascular access and 1 endocarditis). In the 12±10 month follow-up, there was a substantial improvement of the LVEF to 54±14% (p&lt;0.001), and 60 (71%) achieved LVEF normalization. 59 patients (69%) had LVEF improvement ≥10%, only 6 remained in NYHA class 3/4, and AF recurred in 13 (15%). Three patients died during follow-up, and none had LVEF normalization. Predictors of LVEF normalization were: pre-ablation LVEF (OR=1.24, 95%CI 1.12-1.37), left atrial diameter (OR=0.88, 95%CI 0.82-0.95), Chagasic etiology (OR=0.14, 95%CI 0.03-0.77) and indication of amiodarone (OR=0.26, 95%CI 0.09-0.72) and ACEi/ARB (OR=0.25, 95%CI 0.08-0.75, p=0.02). In the multivariable model, independent predictors were: baseline LVEF (OR=1.25, 95% CI 1.10-1.41, p&lt;0.001), left atrial diameter (OR=0.88, 95%CI 0.79-0.98, p=0.02), Chagasic etiology (OR=0.07, 95%CI 0.01-0.74, p=0.03) and indication of ACEi/ARB: (OR: 0.11, 95%CI 0.02-0.63, p=0.01). Conclusion: AF ablation in patients with HF resulted in echocardiographic and functional improvement, with low complication rates. Less clinical severity and morpho-functional impairment associated with LVEF normalization.
Abstract 11748: Prophylactic Aortic Arch Replacement in Patients With Loeys-Dietz Syndrome: Surgical Outcomes and Molecular Rationale
Authors: Albert J Pedroza, Alex R Dalal, Paul Cheng, Emily Tognozzi, Olivia Mitchel, Nobu Yokoyama, Ken Nakamura, Thomas Quertermous, Michael P Fischbein
Journal: Circulation (2022)

Introduction: Loeys-Dietz syndrome (LDS) patients typically develop focal aortic root aneurysm but have substantial risk of distal aortic events (arch aneurysm and type B dissection) after root replacement. We offer prophylactic arch replacement to LDS patients of all genotypes undergoing elective valve-sparing aortic root replacement (VSARR) to prevent late aortic events. We hypothesized that non-dilated LDS aortic arch tissue demonstrates ongoing deterioration at the time of VSARR. Methods: Aortic tissue was anatomically segmented (root, ascending, arch) then examined via histology and single-cell RNA sequencing (‘scRNAseq’, n=4 patients) to comprehensively profile cellular phenotypes. Results: LDS patients (n=8, mean age 37.9 years, 87.5% male) had root aneurysm (mean 45.1 ± 8.9mm) without ascending (35.1± 7.8mm) or arch dilation (28.7 ± 2.8mm) and underwent concurrent VSARR and branched graft total arch replacement. There were no perioperative deaths or strokes and no distal aortic events or reoperations after median 1.26 years follow-up. Histologically, elastin fragmentation and collagen deposition were detectable in each aortic segment (n=4). scRNAseq identified a continuum of smooth muscle cell (SMC) phenotype modulation associated with progressively reduced contractile gene expression. Pathway analysis of 260 genes enriched during SMC modulation identified heightened integrin signaling, transforming growth factor-beta-responsiveness, cell adhesion, and extracellular matrix remodeling. Histologic confirmation using RNA probes specific for modulated SMCs (TGF-beta responsive gene SERPINE1 and glycoprotein TNFRSF11B ) identified these cells in the tunica media layer of each aortic segment, with greatest density in the root aneurysm but extending to the arch. In age-matched donor aortas, TNFRSF11B + cells were restricted to the atherosclerotic tunica intima, confirming specificity of medial SMC modulation in aneurysm. Conclusions: Total arch replacement during elective VSARR is feasible without substantial morbidity. In LDS patients with root aneurysm, matrix deterioration and SMC phenotype modulation are present in the non-dilated aortic arch, providing molecular rationale for aggressive arch replacement.
Abstract 11111: In-Hospital Outcomes of Coronary Atherectomy in Teaching vs Non-Teaching Hospitals
Authors: Ali Horoub, Favour Markson, Tasnim Sholi, FNU Farukhuddin, Michael Fatuyi, Mohammad Diabat, Mohannad Al-Khateeb, Richard Orji, Yazan Al Jabiri, Onoriode Kesiena, Muhammad H Maqsood, Mubarak Yusuf, Yassine Kilani
Journal: Circulation (2022)

INTRODUCTION: Studies have analyzed contemporary data on outcomes at teaching vs non-teaching hospitals with the results found to be dissimilar in certain procedures in the United States. Coronary Atherectomy (CA) is a minimally invasive procedure that involves the opening of obstruction from heavily calcified blocked coronaries to improve blood flow to the heart. This study is set out to examine the differences in health care outcomes between teaching and non-teaching hospitals in patients who underwent CA using a nationally representative sample. METHODS: We reviewed data from the National Inpatient Sample (NIS) of patients admitted between 2016-2019. Using ICD-10 procedural codes, we identified patients who underwent CA (Rotational or Orbital) within the study period. We further categorized our study population into 2 groups based on teaching vs non-teaching status. Multivariate analysis was done to investigate the in-hospital outcomes between both groups and adjust for confounders. RESULTS: A total of 171,740 CA procedures were performed within the study period. 75% (129,585) vs 25% (42,155) of these procedures were performed in teaching vs non-teaching hospitals respectively. The mean age of patients who underwent the procedure was 65 years, with a higher preponderance in males (71.4%). There was no significant difference in in-hospital mortality in both groups (AOR 1.06, 95% CI 0.93 -1.21, p=0.372). There was also no observed difference in the odds of coronary perforation or cardiac tamponade (AOR 1.26, 95% CI 0.89-1.28 p=0.19) and (AOR 1.23, 95% CI 0.82-1.87, p=0.31) respectively. However, the teaching hospital groups had an increased odds of Coronary dissection (AOR 1.34, 95% CI 1.05 - 1.71, p=0.017) and heart Block (AOR 1.22, 95% CI 1.11-1.34, p&lt; 0.001). We also noticed an increased odds of septic shock (AOR 1.24, 95% CI 1.05-1.80, p= 0.018), AKI (AOR 1.12, 95% CI 1.07-1.22, p=0.005) and a higher hospitalization duration (Adjusted coefficient 0.43, 95% CI 0.30-0.56, p&lt; 0.001) in the teaching hospital group . CONCLUSION: CA performed at teaching hospitals is found to be associated with an increased risk of cardiac (coronary dissection and heart block) and non-cardiac (septic shock and AKI) outcomes.
Abstract 12085: Cardiac Structural and Functional Differences Between the Types of Sleep Apnea in Patients With Heart Failure With Reduced Ejection Fraction
Authors: Shoichito Yatsu, Christian Horvath, Tomoyuki Tobushi, Anna Woo, John Floras, Alexander G Logan, Douglas Bradley
Journal: Circulation (2022)

Introduction: In patients with heart failure with reduced ejection fraction (HFrEF), sleep-disordered breathing (SDB) may affect, or be affected by cardiac structure and function. We hypothesized that patients with OSA would demonstrate left ventricular (LV) remodeling and impaired LV function intermediate between that of patients with CSA and patients with no SDB. Methods: ADVENT-HF is a multinational randomized trial investigating the effect of adaptive servo ventilation in patients with HFrEF and SDB. Inclusion required LV ejection fraction (LVEF) ≤45%, and a polysomnographic (PSG) apnea-hypopnea index (AHI) ≥15. Subjects with an AHI &lt;15 were excluded from randomization but comprised a no-SDB (NSDB) group. All transthoracic echocardiograms (TTE) and PSGs were analyzed in core laboratories at University Health Network in Toronto. Patients with SDB were subdivided into those with OSA and those with CSA. We then compared baseline demographic and TTE characteristics of the NSDB, OSA and CSA cohorts. Results: Among them, 665 with acceptable TTE were analyzed. As shown in the table, the CSA group was older, more predominantly male, and had a higher AHI than the other groups, and a higher prevalence of atrial fibrillation and a lower minimum arterial oxyhemoglobin saturation level than the NSDB group. The CSA group also had greater LV mass index than the other groups, greater LV volume indices and lower LVEF than the OSA group, and lower cardiac index than the NSDB group. Although the OSA group had no significant differences in TTE findings compared to the NSDB group, the OSA group was older, more predominantly male, and had a greater AHI than the NSDB group and a higher BMI than the CSA group and lower minSaO 2 than the other groups. Conclusion: In patients with HFrEF, the degree of LV remodeling and dysfunction did not differ between the OSA and NSDB groups, but those with CSA had more advanced LV remodeling and dysfunction than the other groups signaling more advanced HF.
Abstract 11174: Hypertension in Hispanics/Latinos is Associated with Adverse Alterations in Cardiac Structure and Function
Authors: Nga Nguyen, Waseem Nosair, Brian Claggett, Maria Pabon, Carlos J Rodriguez, Scott Solomon, Susan Cheng, Alvin Chandra
Journal: Circulation (2022)

Introduction: Hispanic/Latino adults have been reported to be less aware of their hypertension (HTN) diagnosis and less likely to be on treatment compared to non-Hispanic white and black adults. These disparities suggest that Hispanic adults with HTN are at high risk for developing structural heart disease. Yet, limited data exist regarding how HTN affects cardiac structure and function in this population. Hypothesis: Higher long-term antecedent blood pressure (BP) level is associated with adverse changes in cardiac structure and function in Hispanic/Latino adults. Methods: The study sample consisted of 6,144 participants of the Hispanic Community Health Study/Study of Latinos free of prior cardiovascular disease who had BP measured at visits 1 and 2 (2010-2011 and 2014-2017, respectively) and underwent echocardiography at visit 2. Mean systolic and diastolic BP were averaged across visits 1 and 2. Those who were taking antihypertensive medications were imputed as follows: values for systolic BP (+10 mmHg) and diastolic BP (+5 mmHg). Results: Mean age was 57±10 years, 54% were women. 48% had imputed mean systolic BP ≥130 or diastolic BP ≥80 mmHg. Increasing age, body mass index (BMI), diabetes prevalence, and worsening kidney function were associated with more severe hypertension. Increasing mean BP was associated with increased prevalence of concentric remodeling and concentric left ventricular (LV) hypertrophy. Higher BP was also associated with adverse changes in diastolic function parameters including left atrial volume index, septal e’, E/A ratio, and E/e’. These differences persisted after adjusting for age, sex, Hispanic subgroup, BMI, kidney function, diabetes, alcohol use, and cholesterol level. LV ejection fraction did not significantly differ across BP groups. Conclusions: Increased prevalence of HTN in a Hispanic/Latino adult population is associated with LV hypertrophy, concentric remodeling, and diastolic dysfunction.